Compression bandages or stockings vs. no compression for treating venous leg ulcers

Shi C, Dumville JC, Cullum N, Connaughton E, NormanG. Compression bandages or stockings versus no compression for treating venous leg ulcers. Cochrane Database of Systematic Reviews 2021, No. 7. Art. No.: CD013397. doi: 10.1002 /14651858.CD013397.pub2. Accessed July 27, 2021.

Commentary

The purpose of this study was to evaluate the effect of the use of compression bandages or stockings compared to no compression on the healing of venous leg ulcers in a population of all conditions.

The main result

was that the review included 14 studies (1391 participants).

It must be understood that most of these studies were small. (Median study sample size: 51 participants)

Participants were recruited in acute care, outpatient, and community settings. 65.9% of participants had a history of chronic venous disease, clinical evidence, a confirmed cause of chronic venous insufficiency, and an ankle pressure/brachial pressure ratio greater than 0.8 to 0.9.

The mean median age was 70.1 years, the median duration of leg ulcers was 22.0 months, and 64.8% of participants had ulcers with an area of 5 to 20 cm.

The median follow-up of the study was 12 weeks. The compression bandages or stockings applied included short stretch bandages, four-layer compression bandages, and Unna boots, and the comparison group used included "usual care," pharmacological treatments, and various bandages.

(1) Those who wear compression bandages and stockings may have a shorter time to complete healing of venous leg ulcers than those who do not wear compression.

(2) It has also been shown that people treated with compression bandages and stockings are more likely to experience complete healing within 12 months compared to those who do not wear compression.

The synthesis without meta-analysis suggests that ulcers healed more completely with compression bandages or stockings than without compression.

They also did not know if there was a difference in the incidence of adverse events.

As a secondary result,

users probably had lower mean pain scores than those who did not use them, suggesting a reduction in leg ulcer pain. They suggest that it may improve disease-specific quality of life, but not all aspects of health status.

The authors conclude that

When using compression bandages and stockings, people with venous leg ulcers probably experience faster complete wound healing, and more people heal their wounds completely. There is also the possibility of possibly reducing pain and improving the quality of life specific to the disease. However, there is uncertainty about adverse effects and cost-effectiveness, according to the report.

Future studies should focus on comparing alternative bandages and stockings with the primary endpoints for completing wound healing along with adverse events such as pain scores and health-related quality of life, and should incorporate cost-effectiveness analysis where possible.

Future studies will need to comply with international standards for trial conduct and reporting.